Prenatal Education & Infertility Flashcards
What is the overall goal of prenatal education ?
empowerment so that the patient can make a informed decision about their pregnancy
How do we empower the woman in her pregnancy ?
- give options for safe delivery of care
- recognize that the patient has a right to evidence-based, accurate and complete information
- recognize that the patient’s choice may align with their cultural and personal values and preferences
What does Early Pregnancy education look like ?
knowing the expected changes your body goes through
- fetal development
- physiological/emotional changes
- sexuality
- nutrition
What does Mid Pregnancy education look like ?
prepping the patients for parenting
- breastfeeding
- infant health and care
- safe sleep methods
- parenting
- changing diapers
What does Late Pregnancy education look like ?
preparing for delivery and the birthing process
- coping with labor and birth
- touring the location where you may be giving birth
What is considered a low-risk pregnancy ?
pregnancy with no previous or current maternal or fetal implications
What is a doula ?
a person who offers support during labor and postpartum
- can be certified
- usage has shown to reduce use of analgesics, shorten labor, increase satisfaction with delivery, increase breastfeeding, increase likelihood of spontaneous vaginal delivery
What is a Certified Nurse Midwife ?
has a Nursing background and a advanced degree
- Masters in midwifery
What is a Direct-Entry Midwife ?
is credentialed but got this without a Nursing background
- has formal education and is certified
What is a Traditional/Lay Midwife ?
not certified by instead trained by self-study or apprenticeship
What is a birth plan ?
a tool in which parents can explore childbirth options and develop a “plan” for the day
- helps communicate preferences to healthcare team
- can give pt’s a sense of control and responsibility
What are some considerations with a birth plan ?
- should be fluid and flexible
- verify with healthcare providers before delivery starts to ensure they are all in agreement
- nurses discuss lots of these options at admission
- mobility
- fetal monitoring
- surroundings
- partner participation
- episiotomy, forceps or vacuum
- IV
- C/section
- bonding
What is the purpose of childbirth preparation classes ?
prepare and practice coping mechanisms for labor pain experience
What are the 6 core principles of Lamaze ?
- labor begins on its own
- freedom of movement is crucial
- importance of continued labor support
- avoid non-medically necessary interventions
- non supine position for delivery
- no separation of mom and baby after birth for unlimited breastfeeding opportunities
What is the Dick-Read technique ?
focuses on the fear, tension and pain cycle
- says that fear causes tension which then increases pain
- comes from “childbirth without fear” book from UK physician
What is the Gaskin maneuver ?
it frees the baby’s shoulder when its stuck behind the mom’s pelvic bone
What is the Gaskin technique ?
its a low intervention technique to reduce fear during delivery
- have a calm environment and encourage mom with certain words when afraid
What does the Lamaze technique promote ?
an unmedicated no intervention birth and a positive bonding experience with baby
- control of pain through breathing techniques
- most well known
What is the Bradley technique ?
similar to Lamaze but has a reinforced coach at the bed-side
- used to be known as the husband coach childbirth
- used to be innovative but now questionable because it gives power to the husband/coach over the person giving birth
What is the LeBoyer technique ?
infant focused waterbirth
- it focuses more on the newborn experience
- quiet room with dim lighting
- water transition after birth
- good option for low risk moms
What is Hypnobirthing ?
a self-hypnosis technique that helps reduce fear of delivery with women
- you train the brain to achieve deep relaxation
- involves positive affirmations, and takes practice
- pt’s are still fully aware and participate in birthing process
Why may someone choose placental consumption ?
says it helps prevent postpartum depression and bleeding
- increases mom’s milk supply and helps patient get back iron that was lost during delivery
- usually placenta is packaged into capsules that are consumed
What is a gentle c-section ?
this is more about the experience
- there is a clear drape so the pt can see more of what is happening during the procedure
- skin to skin in OR
- play music and delayed cord clamping
Why may delayed 1st bath be chosen ?
shown to increase breastfeeding and decrease hypothermia and hypoglycemia
- wait at least 8 hrs or even longer
What is delayed cord clamping ?
lets baby get the most blood from the placenta and cord for as long as possible
- wait about 30-60 secs before cutting
- can be down with term and preterm baby’s
- increases the iron levels
What is a Lotus Birth ?
leaving placenta attached until the umbilical cord falls off naturally
- INFECTION RISK and not lots of data to support this
- says it can increase blood and nourishment to the baby
- less invasive transition from womb to external world
- can be a ritual to honor shared life from baby and placenta
What is vaginal seeding ?
using cotton swabs or balls that have vaginal fluid on them and placing that on baby’s mouth, nose or skin
- still being studied
- helps replicate the microbiome that baby’s go through during vaginal births for C-section baby’s
- evidence that it decreases chances of asthma, immune disorders and entopic disease
What is the definition of infertility ?
couples who haven’t been able to get pregnant:
- after 1 year of regular unprotected intercourse when the woman is less then 35 yrs of age
- or after 6 months when the woman is over the age of 35
Why does the definition of infertility change based on the woman’s age ?
fertility naturally decreases as you go over the age of 35 yrs old
Before the age of 35, what is the chance of getting pregnant each month ?
25-30%
What percentage of couples get pregnant within 6 months ?
80%
- this is why you wait the 6 months before you take extra steps
What is the difference between primary and secondary infertility ?
- Primary: pt has never been pregnant before
- Secondary: pt has been pregnant before
What are some risk factors for female infertility ?
- Hx of STDs: can cause scar tissue and this can impair fallopian tube uptake
- certain meds can cause infertility
- genetics
- Turner’s syndrome: only 1 chromosome
- PCOS: ovary fails to release eggs regularly (hormonal)
- smoking & drinking
- over the age of 35 yrs
- irregular periods: hard to track ovulation cycle
- any uterine disorder that causes scar tissue
- past cancers
- obesity
What are some risk factors of male infertility ?
- congenital disorders
- nutrional deficiencies
- obesity
- substance abuse & smoking
- endocrine disorders (diabetes)
- Hypospadias: urethra opening is on the underside instead of tip of penis
- Varicoceles: enlarged veins in the testicles that can impair sperm count and motility
- STIs
- environmental toxins: pesticides, lead, radiation
- medications: some anti-hypertensives
What are the most common issue that cause male infertility ?
hormone and sperm transport issues
What is the first step in fertility testing ?
a thorough history and physical, lab work, and semen analysis
- least to most invasive
What is the purpose of a pelvic ultrasound in fertility testing ?
looking for abnormal uterine anatomy
In the female blood work, what levels may we look at for fertility testing ?
- estrogen
- progesterone
- follicle stimulating hormone (FSH)
In the male blood work, what levels may we look at for fertility testing ?
- testosterone
- follicle stimulating hormone (FSH)
- gonadotropin
In semen analysis testing for fertility, what do they look at ?
sperm count, shape and motility
What are the female testing methods for fertility ?
- hormone testing (blood work)
- pelvic ultrasound
- hysteroscopy
- hysterosalpingography
What is the purpose of a hysteroscopy in fertility testing ?
inserting a camera into the uterus to look at the health of the uterus
- looking for abnormalities
What is the purpose of a hysterosalpingography in fertility testing ?
usage of X-ray to look at the uterus and fallopian tubes for blockages or abnormalities
- you fill up the uterine space with a dye which then creates a outline of the uterus and fallopian tubes that can be seen through a X-ray to be examined
What are the male testing methods for fertility ?
- semen analysis
- physical exam
- homone test (blood work)
What are some medical therapy methods to treat fertility ?
- Clomid
- Hormones: progesterone, gonadotropins & FSH supplements
- metformin
How does Clomid help in fertility ?
helps stimulate ovarian function and ovulation
- common 1st line med for couple that has tried for 6 months or 1 yr
- increases risk of multi-fetal pregnancy (especially twins or triplets)
How does Metformin help in fertility ?
helps induce ovulation by reducing the insulin resistance
- good option for pt’s with PCOS (polycystic ovarian syndrome)
What is IVF ?
invitro fertilization
- collect eggs and sperm then you fertilizes the 2 in a lab which creates a embryo which can be transferred into the uterus
- “test tube” baby
- very expensive
- can be from 12,000-20,000 (average is 15,000) and not typically covered by insurance
What is IUI ?
intrauterine insemination
- you place quality sperm into the uterus at the time of ovulation
- good option for men with low sperm count and motility
- much cheaper then IVF
- about 1,000
What is the difference between a surrogate mother and gestation carrier ?
- Gestation Carrier: has no genetic link with the fetus
- Surrogate Mother: shares genetic link with the baby and gets paid to do this (have to had at least 1 previous successful pregnancy)
What is preimplantation genetic diagnosis ?
taking an embryo and doing testing to identify any genetic disorders
Why is embryo storage so controversial ?
what happens to the extra embryo’s you don’t use
- ethical dilemma
- do you donate to another person or to research ?
What is selective reduction ?
when you implant multiple embryo’s to see how many take and then chose from those which to keep
- Ex.) you implant 6 and then all 6 take so now you have 6 embryo’s but that is a high risk pregnancy so you choose which embryo’s to keep
- want to avoid complications
What are some risk for having multiple fetuses in 1 pregnancy ?
- preterm labor
- postpartum hemorrhage
- preterm delivery
- baby’s can end up in NICU (costly)
What is Endometriosis ?
where the tissue that normally lines the uterus (endometrium) appears in locations where it shouldn’t
- typically found around the reproductive organs
- causes legions to form which can lead to scar tissue which can lead to infertility
Why can scar tissue lead to miscarriage ?
placentas don’t like to grow where there is scar tissue so there is an increased risk for miscarriage
What are some S&S of Endometriosis ?
inflammatory response:
- pelvic pain
- dysmenorrhea (painful periods or cramps)
- painful intercourse
What are some treatment options for Endometriosis ?
- NSAIDS during menstruation (for mild symptoms)
- oral contraceptives (low dose): can be take for a long period of time and help prevent tissue forming outside the uterus, make periods shorter, and reduce inflammation
- GnRH agonist: can medically induced menopause which can help suppress the endometrial lesion formation
- laparoscopy: removal of lesions if you have more severe symptoms (can still get pregnant)
- TAH (total abdominal hysterectomy): for pt’s that don’t want to get pregnant and if symptoms are bad
